The Role of Cetrotide Acetate in Prevention of Ovarian Hyperstimulation Syndrome (OHSS) in Oocyte Donors
Primary Purpose
Ovarian Hyperstimulation Syndrome
Status
Completed
Phase
Not Applicable
Locations
United States
Study Type
Interventional
Intervention
Cetrotide acetate
Sponsored by
About this trial
This is an interventional prevention trial for Ovarian Hyperstimulation Syndrome focused on measuring ovarian hyperstimulation syndrome, cetrotide acetate, GnRH antagonist, oocyte donors
Eligibility Criteria
Inclusion Criteria:
- Prospective donors with BMIs between 19 and 28,
- Those with normal FSH levels and good antral follicle counts between 19-28 years of age, AND
- Donors would have passed all the required testing as mandated by VCRM and the FDA.
Exclusion Criteria:
- Oocyte donors exceeding a BMI of > 28,
- Those with any communicable diseases,
- Those with low antral follicle counts and small ovarian volumes,
- Those with elevated FSH levels,
- Those with positive sickle cell screen or cystic fibrosis screening,
- Smokers, OR
- Donors who are unable or unwilling to follow the research protocols.
Sites / Locations
- Virginia Center for Reproductive Medicine
Arms of the Study
Arm 1
Arm Type
Experimental
Arm Label
Cetrotide acetate
Arm Description
oocyte donors will receive cetrotide acetate on the day of oocyte retrieval. The incidence of OHSS will be assessed.
Outcomes
Primary Outcome Measures
Volume of Ascites in the Abdomen is Indicative of the Severity of OHSS
evaluate by ultrasound examination, physical examination and blood work the incidence of ovarian hyperstimulation syndrome in oocyte donors receiving a single injection of 3 mg Cetrotide Acetate.
Ovarian Volumes as a Predictor of OHSS Severity
ultrasound measurements of both ovaries
Secondary Outcome Measures
Full Information
NCT ID
NCT00867659
First Posted
March 21, 2009
Last Updated
March 26, 2013
Sponsor
Virginia Center for Reproductive Medicine
1. Study Identification
Unique Protocol Identification Number
NCT00867659
Brief Title
The Role of Cetrotide Acetate in Prevention of Ovarian Hyperstimulation Syndrome (OHSS) in Oocyte Donors
Official Title
The Role of Cetrotide Acetate in Prevention of Ovarian Hyperstimulation Syndrome in Oocyte Donors
Study Type
Interventional
2. Study Status
Record Verification Date
March 2013
Overall Recruitment Status
Completed
Study Start Date
March 2009 (undefined)
Primary Completion Date
October 2011 (Actual)
Study Completion Date
October 2011 (Actual)
3. Sponsor/Collaborators
Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
Virginia Center for Reproductive Medicine
4. Oversight
Data Monitoring Committee
Yes
5. Study Description
Brief Summary
This pilot study aims to address whether the prophylactic use of Cetrorelix Acetate after a long gonadotropin-releasing hormone (GnRH) agonist protocol post-hCG (human chorionic gonadotropin) administration can significantly reduce the incidence of OHSS in oocyte donors.
Detailed Description
With varying complications, OHSS is an iatrogenic condition cause by ovarian stimulation. Classified as mild, moderate, or severe, mild OHSS is relatively common as it occurs in up to 1/3 of women undergoing ovarian stimulation. Symptoms include abdominal ascites, nausea, vomiting, increased abdominal girth and weight gain, with increasing ranges for mild to moderate. Severe OHSS occurs in 1% and includes hemodynamic instability, thrombosis, pulmonary difficulties, oliguria, and rarely death. Therefore, strategies to prevent or severely decrease the incidence of OHSS are sorely needed.
More aggressive ovarian stimulation increases the risk of OHSS, but it is not easy to predict who or who will not develop OHSS. Certain patient types, however, are considered to be at a higher risk than others, including oocyte donors. OHSS in oocyte donors manifests early, i.e. within days of oocyte retrieval, yet does not have the continued complication of pregnancy as observed in IVF patients. Therefore, as a in this vulnerable patient population, oocyte donors are ideal to study.
GnRH antagonists been most recently used in high risk patients undergoing IVF. Aside the reduction of OHSS observed after the traditional utilization of the antagonist protocol, alternative uses have also suggested favorable outcomes. Two retrospective, cohort matched studies evaluated a Ganirelix Acetate substitution in women who were at high risk for developing OHSS (E2 > 2,000 pg/ml on cycle day 6 or a projected peak E2 > 5,000 pg/ml with > 25 follicles on the day of HCG administration) after being down-regulated using GnRHa (or using a microdose flare protocol) and undergoing ovarian stimulation The GnRHa was stopped and only a low dose of hMG was continued when Ganirelix Acetate was started. The Ganirelix Acetate use resulted in an average drop of 41-49.5% in peak E2 levels. While those two studies were provocative, they were retrospective and not controlled. In the only prospective study evaluating the use of Ganirelix Acetate in the prevention of OHSS compared to coasting, the "historic" gold standard, Ganirelix Acetate resulted in a 36% drop in E2 level after one injection and a 59% drop in peak E2 after 3 days of use (46.8% required only one injection, 38.3% required two, and only 14.9% required 3 injections) as opposed to a 9% increase in E2 level 24 hours after coasting. The use of Ganirelix acetate resulted in significant decrease in OHSS risk (2.1-2.3% in the two retrospective studies, and 0% in the only prospective study vs 9-38% in prior publications) without affecting the pregnancy outcome. The mean number of Ganirelix Acetate injections was 1.74 + 0.91. Although, Ganirelix Acetate appears to be successful in lowering the OHSS risk previous to hCG administration as suggested by these studies, this pilot study questions the effect after the ovulation induction is administered. To date, no such study has asked this question.
All donors will be evaluated daily with hormonal levels (FSH, LH, E2, P, CBC, and comprehensive metabolic profile (which includes liver function tests) for at least 3 days after the oocyte retrieval. Daily weights and abdominal circumference will also be measured. All oocyte donors will also present for one last visit one week after oocyte retrieval. The incidence of OHSS will be the main outcome measured.
6. Conditions and Keywords
Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Ovarian Hyperstimulation Syndrome
Keywords
ovarian hyperstimulation syndrome, cetrotide acetate, GnRH antagonist, oocyte donors
7. Study Design
Primary Purpose
Prevention
Study Phase
Not Applicable
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
Non-Randomized
Enrollment
20 (Actual)
8. Arms, Groups, and Interventions
Arm Title
Cetrotide acetate
Arm Type
Experimental
Arm Description
oocyte donors will receive cetrotide acetate on the day of oocyte retrieval. The incidence of OHSS will be assessed.
Intervention Type
Drug
Intervention Name(s)
Cetrotide acetate
Intervention Description
cetrotide acetate is a GnRH antagonist. The dose is 3 mg once on the day of oocyte retrieval.
Primary Outcome Measure Information:
Title
Volume of Ascites in the Abdomen is Indicative of the Severity of OHSS
Description
evaluate by ultrasound examination, physical examination and blood work the incidence of ovarian hyperstimulation syndrome in oocyte donors receiving a single injection of 3 mg Cetrotide Acetate.
Time Frame
4 weeks
Title
Ovarian Volumes as a Predictor of OHSS Severity
Description
ultrasound measurements of both ovaries
Time Frame
30 days
10. Eligibility
Sex
Female
Minimum Age & Unit of Time
19 Years
Maximum Age & Unit of Time
32 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria:
Prospective donors with BMIs between 19 and 28,
Those with normal FSH levels and good antral follicle counts between 19-28 years of age, AND
Donors would have passed all the required testing as mandated by VCRM and the FDA.
Exclusion Criteria:
Oocyte donors exceeding a BMI of > 28,
Those with any communicable diseases,
Those with low antral follicle counts and small ovarian volumes,
Those with elevated FSH levels,
Those with positive sickle cell screen or cystic fibrosis screening,
Smokers, OR
Donors who are unable or unwilling to follow the research protocols.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Fady I Sharara, M.D
Organizational Affiliation
Virginia Center for Reproductive Medicine
Official's Role
Principal Investigator
Facility Information:
Facility Name
Virginia Center for Reproductive Medicine
City
Reston
State/Province
Virginia
ZIP/Postal Code
20190
Country
United States
12. IPD Sharing Statement
Learn more about this trial
The Role of Cetrotide Acetate in Prevention of Ovarian Hyperstimulation Syndrome (OHSS) in Oocyte Donors
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